The rule states that if a child (<16y of age) with an ankle injury has a low-risk examination, ankle radiography may not be necessary to further exclude a high-risk injury such as fractures of the foot, distal tibia, fibula proximal to the distal physis, tibiofibular syndesmosis injury and ankle dislocations.
Low-risk ankle injuries include lateral ankle sprains, nondisplaced Salter-Harris types I and II fracturs of the distal fibula, and avulsion fractures of the distal fibula and lateral talus, which can all be managed functionally by supportive splinting and returned to activities as tolerated by the patient.
High Risk:
- Tenderness and/or edema over distal tibia + growth plate
- Tenderness and/or edema over calcaneus
Low Risk:
- Tenderness and/or edema over distal fibula + growth plate
- Tenderness and/or edema over lateral ligaments + anterior talofibular, calcaneofibular & posterior talofibular ligaments
| Study | Reliability | Sn | Sp | LR+ | LR- |
| Boutis et al. (2013) | NA | 98 | 54 | 2.13 | 0.04 |
| Gravel et al. (2009) | NA | 76 | 56 | 1.73 | 0.43 |
| Comment: In both studies, different definitions for ‘clinically important’ fractures have been used which leads to the differences in sensitivity values | |||||
